Fillable Printable Application for Certified Copy of Kansas Marriage Certificate - Kansas
Fillable Printable Application for Certified Copy of Kansas Marriage Certificate - Kansas
Application for Certified Copy of Kansas Marriage Certificate - Kansas
Address:City/State:Zip:
Email:
SelfFatherPaternal Uncle
MotherBrotherMaternal Uncle
SisterSonPaternal Aunt
Current Spouse
DaughterMaternal Aunt
Party A
FIRST MIDDLE LAST Last Name Prior to First Marriage (if different)
Date of Birth:
Check one: Bride Groom Spouse
Party B
FIRST MIDDLE LAST Last Name Prior to First Marriage (if different)
Date of Birth:
Check one: Bride Groom Spouse
$Total:
*Requirements-Read before turning in application
1) This request form must be completed.
Type/ID #
2) Enclose a copy of both front and back of a current legal photo ID
(see back for list of acceptable ID's)
3) Enclose appropriate fees
4) Person requesting to receive a certificate must sign above.
5) If submitting by mail, enclose a self-addressed stamped envelope
Amount given
$
Chg provided
$
*Request will be returned if the above steps are not completed correctly.
OFFICE USE ONLY
City that Marriage took place:
Name on Record:
MO/DAY/YEAR
Date of Marriage:
County that issued license:
MONTH DAY YEAR
COUNTY STATE(MUST BE KANSAS)
MO/DAY/YEAR
Maternal Grandparent
Other (specify)
Phone Number:
1000 SW Jackson Suite 120
Application for Certified Copy of Kansas Marriage Certificate
*IF THE CERTIFICATE IS NOT LOCATED, A $15.00 FEE
MUST BE RETAINED
BY THIS DEPARTMENT FOR THE RECORD SEARCH
.
Make checks or money orders payable to Kansas Vital Statistics. For your protection,do not send cash.
Fees
K.A.R. 28-17-6 requires the following fee(s).
The correct fee must be submitted with the request. The fee for certified copies of marriage certificates is $15.00 for each certified copy. This
fee allows a 5-year search of the records, including the year indicated plus two years before and two years after, or you may indicate the
consecutive 5-year period you want searched. You may specify more than one 5-year span, but each search will cost $15.00.
Marriage Information
(person requesting the certificate)
Name of Requestor:
Requestor's Signature:
Paternal Grandparent
Legal Guardian(submit custody order)
*IMPORTANT: The person requesting the vital record must submit a copy of their identification. See lis t on reverse side.
Requestor's relationship to person on the Certificate? (Check one)
Reason for Request (PLEASE BE SPECIFIC):
Name on Record:
* PLEASE NOTE MARRIAGE CERTIFICATES ARE ON FILE FROM May 1, 1913 TO PRESENT
9:00a.m.-4:00 p.m.
Today's Date:
Station/# of apps _______________________________ Exp ____________________________
Topeka, KS 66612-2221
Monday-Friday
Payment Type CASH CHECK CCARD MO
INITIAL
VS-237 3/15
$15 per Certified Copy
Office hours:(live phones)
Kansas Office of Vital Statistics
Number of Copies Ordered:
Mon-Fri 8:00a.m.-5:00 p.m.
Walk-in Hours:
Phone: 785-296-1400
◦ Bureau of Indian Affairs Tribal ID card of Requestor
◦ Inmate ID of Requestor(along with a memo completed and signed by a counselor or parole officer)
◦ Niece/Nephew
Who's Eligible to Obtain Most Certificates: Must provide ID and proof of direct
interest
Requestor's current ID required To Get a Certificate:
Eligibility
ONE form of Primary Documentation required from list below
◦ Utility Bill with current address of Requestor and company letterhead with company name and address; not handwritten
◦ Current Pay Stub (must include your name, social security number plus name and address of business; not handwritten)
◦ Valid insurance card or policy of Requestor
◦ Valid health insurance card or policy of Requestor
◦ Parole document (book sheet) of Requestor
◦ Car Registration or Title with Requestor's current address
1) FEES EXPIRE 12 MONTHS FROM THE DATE OF THE REQUEST.
2) MULTIPLE REQUESTS FOR DIFFERENT RECORDS MAY BE HANDLED AND MAILED SEPARATELY.
WARNING: COPYING, ALTERING, or FRAUDULENT ACTIVITY PROHIBITED
Except as authorized by the Uniform Vital Statistics Act, no person shall prepare or issue any certificate (vital record) which purports to be an
original, certified copy or abstract or copy of a certificate [K.S.A. 65‑2422d.(g)]. Vital records identity theft related to obtaining certificates or
making, counterfeiting, altering, amending any certified copy of a vital record with the intent to sell or obtain for any purpose of deception a
certified copy of a vital record is a severity level 8, nonperson felony. [K.S.A. 21-3830a (d) and K.S.A 21-3830a (e)].
◦ Letter from employer (with Requestor's current address)
◦ U.S. Voters registration card of Requestor
◦ Filed Income Tax of Requestor with current address
◦ Letter to Requestor from Social Service Agency/Health Department or other government agency with current address
◦ Hospital or Health agency bill (with current address) of Requestor
◦ Court Documents of Requestor
◦ W-2 from Employer (with Requestor's current address)
Read: IMPORTANT MISCELLANEOUS INFORMATION
By State law, vital records filed with this office are not open for public
inspection and the requestor must meet eligibility requirements -- must be
named on the record, an immediate family member, or someone who can
provide legal proof the record is necessary for the determination of personal or
property rights. [K.S.A. 65-2422d]
◦ Parents
Please make a copy of one of the following documents and
send with the application. All documents MUST
be signed,
current and valid. All Identification must have both sides and
be able to be read.
◦ Voter's registration card (Countries outside of the U.S.)
◦ Social Security card (must be signed by card holder)
◦ Bank Statement with Requestor's current address
* PLEASE NOTE MATRICULAS ARE NOT AN ACCEPTABLE FORM
OF ID
If legal guardianship has been established through the courts, please provide a
copy of the guardianship papers.
◦ Resident Alien card
◦ Siblings
◦ Refugee Travel Document
◦ Certificate of Naturalization (with intact photo)
◦ Concealed Carry handgun license
◦ Must be age 18 or older
◦ VA Card (with intact photo)
If you do not have a government issued photo ID, you must send photocopies of any two of the following: *Photocopies must
be of the complete document, able to be read and be the Requestor's with current address
◦ Temporary Driver's License
◦ Aunts/Uncles
◦ Photocopy of Government Issued Driver's License, Military ID,
State ID card, Valid Passport and Visa's. (Not the credit/debit
card)
◦ Permanent resident card
◦ Alien registration receipt card
◦ Employment authorization card
◦ Re-entry permit
◦ Current Spouse
◦ Adult Children
◦ Grandparents
Detailed Information
Identification
